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World J Gastroenterol. Sep 28, 2014; 20(36): 13153-13158
Published online Sep 28, 2014. doi: 10.3748/wjg.v20.i36.13153
Published online Sep 28, 2014. doi: 10.3748/wjg.v20.i36.13153
Repeat endoscopic retrograde cholangiopancreaticography after failed initial precut sphincterotomy for biliary cannulation
Michael Pavlides, Ashley Barnabas, Nilesh Fernandopulle, Adam A Bailey, Jane Collier, Anthony Ellis, Roger Chapman, Barbara Braden, Translational Gastroenterology Unit, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom
Jane Phillips-Hughes, Department of Radiology, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom
Author contributions: Pavlides M, Barnabas A and Fernandopulle N collected the data; Bailey AA, Collier J, Phillips-Hughes J, Ellis A, Chapman R and Braden B performed the endoscopies and patient management; Braden B designed the study and wrote the manuscript together with Pavlides M; all authors reviewed and approved the final manuscript.
Correspondence to: Barbara Braden, Consultant Gastroenterologist, Professor, Translational Gastroenterology Unit, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom. braden@em.uni-frankfurt.de
Telephone: +44-186-5228760 Fax: +44-186-5228760
Received: March 2, 2014
Revised: May 5, 2014
Accepted: May 26, 2014
Published online: September 28, 2014
Revised: May 5, 2014
Accepted: May 26, 2014
Published online: September 28, 2014
Core Tip
Core tip: Selective biliary cannulation during endoscopic retrograde cholangio-pancreaticography (ERCP) fails in 5%-15%, even in expert high volume centres. Precut sphincterotomy facilitates biliary access, but also has a failure rate. Alternative, more invasive options for achieving biliary therapy, such as percutaneous-endoscopic or endoscopic ultrasound guided rendez-vous procedure, percutaneous transhepatic or surgical intervention include a considerable morbidity. This study demonstrates that repeating the ERCP within a few days after initial failed precut is a successful strategy in the majority of patients and should be tried before contemplating more invasive, alternative interventions.